GASTRO Flashcards

1
Q

Gold standard for coeliac diagnosis

Who is referred for this

A

Biopsy
Jej or duodenum
Looks for villous atrophy. Also get lymphocyte infiltration

Referred if +ve TTG

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2
Q

Most common extra intestinal feature of crohns and UC

A

arthritis

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3
Q

What age group get Achalasia and what would make you think of it

A

Middle age
Difficulty swallowing liquid and food

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4
Q

What would birds beak appearance indicate

A

Barium swallow - achalasia

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5
Q

Adverse effects of Aminosalicylates

A

Agranulocytosis so need FBC.
If they’re allergic to aspirin they might also react to this.

Mesalazine carries 7x risk of pancreatitis

SulFAsalazine - fibrosis, anaemia (Heinz body), oligospermia,

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6
Q

How to tell duodenal vs gastric ulcers on symptoms.

A

The pain associated with duodenal ulcers improves after meals
Pain associated with gastric ulcers generally intensifies after meals.

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7
Q

Who does primary biliary cholangitis commonly affect
How does it commonly present
What was it previously called

A

Middle aged women

Itching in a middle aged woman

Previously primary biliary cirrhosis.

Can get jaundice and xanthomas

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8
Q

What part of body is affected in primary biliary cholangitis and how

A

Interlobular bile ducts become damaged by a chronic inflammatory process ->cholestasis -> cirrhosis.

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9
Q

What condition is associated with primary biliary cholangitis

A

Sjogrens

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10
Q

What investigations to do for primary biliary cholangitis

A

anti-mitochondrial antibodies (AMA) M2 subtype present in 98%

smooth muscle antibodies in 30% of patients

raised serum IgM

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11
Q

Management primary biliary cholangitis

A

first-line: ursodeoxycholic acid
slows disease progression and improves symptoms

pruritus: cholestyramine

fat-soluble vitamin supplementation

liver transplantation
e.g. if bilirubin > 100 (PBC is a major indication)

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12
Q

Primary sclerosis cholangitis - what part of body is affected

A

inflammation and fibrosis of intra and extra-hepatic bile ducts.

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13
Q

What disease is PSC associated with

A

UC

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14
Q

How to investigate PSC and what might you see

A

MRCP/ERCP - beaded appearance (due to strictures)

Also p anca

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15
Q

Complications of PSC

A

cholangiocarcinoma (in 10%)
increased risk of colorectal cancer

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16
Q

Complications of PBC

17
Q

How to induce remission in Crohns

A

Steroids 1st line

2nd line mesalazine

Azathioprine or mercaptopurine can be used as an adjunct but not monotherapy

18
Q

How to maintain remission in Crohns

A

Azathioprine or mercaptopurine

19
Q

How to treat and investigate perianal fistulae in crohns

A

MRI
Metronidazole

20
Q

How to treat proctitis in UC

A

Rectal aminosalicyclates.

If no result after 4 weeks add an oral one

If still no result add topical/ oral steroid

21
Q

How to treat proctosigmoiditis and left-sided ulcerative colitis

A
  1. Rectal aminosalicyclate
  2. Either add oral aminosalicyclate OR oral aminosalicyclate and topical steroid
    3rd line. oral steroids/ oral aminosalicyclates only
22
Q

How to treat extensive UC

A
  1. Topical aminosalicyclate plus a high dose oral one
  2. If after 4 weeks no result stop topical and add oral steroids
23
Q

How to maintain remission in UC

A

Proctitis or proctosigmoiditis: oral or topical aminosalicyclates

If bad then oral aminosalicyclate

24
Q

When would you use azathioprine or mercaptopurine in UC?

A

Following a severe relapse or >=2 exacerbations in the past year

25
how to monitor treatment in haemochromatosis
Ferritin and transferrin saturation
26
Who gets prophylaxis for SBP what is used
Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin
27
What would an alcoholics AST:ALT ratio be like?
AST:ALT greater than 2 (salt before lime in tequila)
28
What would NAFLD AST and ALT ratios look like?
ALT:AST ratio >2.
29
How to tell whether LFTs Hepatitic or biliary probs
Hepatitic - raised ALT more than ALP Biliary - Raised ALP.
30
How can you tell if someone is having crohns flare (single best ix?)
Fecal calprotectin
31
What can thiopurines increase risk of
Non melanoma skin ca
32
What do you see in Gilberts
Increase in unconjugated bili Causes a pre hepatic jaundice picture.
33
How would you differentiate Gilberts from other causes of pre-hepatic jaundice?
No anaemia in Gilberts
34
What is Budd Chiari syndrome? Symptoms? What would you see on MRI?
When you get obstruction to hepatic venous outflow. Hepatomegaly, ascites, abdo pain. Prominent caudate lobe.
35